1,720,988 research outputs found
Cost-Effectiveness of Adrenaline Autoinjectors for Children with Food Allergy
No full textFull Text is available to authenticated members of The University of Auckland only.Children with food allergy live with the risk of anaphylaxis, a life-threatening allergic reaction which requires emergency treatment with an adrenaline autoinjector. The only brand of autoinjector available in New Zealand is the EpiPen, which retails for a minimum of 2,051 and 8,586 per QALY. If either strategy were to be implemented, price negotiations and policy decisions such as the number of devices required per school will affect the thresholds at which each strategy is considered cost-effective. Introducing funded EpiPens is likely feasible and may help alleviate the psychological and financial burden of anaphylaxis for affected families but would require government agencies to prioritise anaphylaxis as a public health issue of importance
Synergising for seniors: Exploring the interplay between inter-organisational collaboration and the effective delivery of integrated care for older people in New Zealand
No full textHealthcare systems face unparalleled socioeconomic challenges, along with the ongoing burden of
managing the COVID-19 pandemic. Thus, there's a push to restructure systems for integration, leading
to diverse collaborative models. New Zealand’s Falls and Fracture Prevention Programme (FFPP)
stands as a notable exemplar of an integrative initiative, targeting falls and fractures among older
people. To date, there is limited understanding of the association between contextual factors at the
organisational and inter-organisational levels and the effective delivery of integrated care. This study
aimed to examine how inter-organisational collaboration, particularly within the FFPP, influences the
achievement of integrated healthcare.
The study utilised a qualitative comparative case study design, whereby four districts were selected
based on their size and organisational arrangement. The Context and Capability for Integrated Care
(CCIC) framework was employed as a tool for capturing and comparing a total of 17 organisational and
inter-organisational factors within and across the selected districts. Through a step-by-step comparative
analysis, this study introduced a novel formulaic approach to measuring the importance level of
organisational factors, covering outcomes and relational impacts. This analytical process shed light on
the complex dynamics of inter-organisational collaboration in the implementation of the whole-system
FFPP, offering insights for similar integrated care initiatives.
The study identified a 3-stage implementation process for the programme: pre-engagement and
engagement, development of service delivery, and establishment of the programme as "business as
usual". During the first stage, adopting a collaborative leadership style, forming a well-structured
governance team, and effectively involving primary care were key organisational and interorganisational factors. In the service development phase, the focus lies on creating cross-referral
pathways and addressing infrastructure issues and building essential relationships among healthcare
professionals across involved organisations to ensure effective service delivery. In the third stage which
aimed at programme sustainability, quality improvement and monitoring, robust mechanisms and
feedback loops played the important role.
Overall, this study highlights the importance level of organisational factors in conjunction with the
lifecycle of inter-organisational collaboration. By following the three distinct stages of implementation,
organisations may increase the likelihood of achieving sustainable and reliable outcomes for preventing
falls and fractures among the elderly
Access to care for people with mental health presentations to Auckland emergency departments
No full textFull Text is available to authenticated members of The University of Auckland only.Emergency Department (ED) specific mental health care utilisation and access data within the New Zealand context are limited. The aim of this thesis is to describe the utilisation patterns and identify unwarranted variations in access to acute ED mental health care.
This was a retrospective quantitative study involving data of all visits in the five EDs within the Auckland Region between July 2018 and June 2019. Descriptive analysis of ED mental health visits was performed. Variations in the access to care were evaluated using total ED length of stay (LOS) as a process measure. Total ED LOS was compared between mental health and non-mental health groups, by dispositions and factor variables.
9,171 (2.4%) of 375,096 ED visits, or 2.8% of adults and 1.4% of paediatrics, were mental health related. Females and Māori were over-represented while Pacific Peoples and Asian were under-represented in mental health visits. Māori and Pacific Peoples were over-represented in the subgroup arriving under Section 109. Mental health patients had higher urgency to be seen, were more likely to present after-hours, and by ambulance or police escort compared to non-mental health patients. The police were involved in 15.9% of mental health presentations. One-third of mental health visits had a primary mental and behavioural diagnosis. 15.2% of mental health presentations required an inpatient mental health bed and a further 3.5% required a community respite bed.
This study revealed several unwarranted variations in access to ED mental health care. The DHB of presentation was the predominant factor in determining total ED LOS. The afternoon and overnight shifts were associated with longer total ED LOS. Mental health ward admissions had longer wait for ED departure after mental health assessment than the routine discharges. The longer first seen time in triage four and triage five mental health visits compared to non-mental health visits were clinically important. Warranted access to care variations included the variations between mental health and non-mental health visits, in age groups, gender, and overall triage category. The challenge now is to reduce the unwarranted access to ED mental health care variations through an ongoing quality improvement process
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Health Reforms In Tanzania: From Self-Reliance To Donor Dependency and Efforts to Return to Self-Reliance
No full textVariations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
The Impact of COVID-19 on Primary Care Practitioners: Transformation, Upheaval and Uncertainty
No full textThe COVID-19 pandemic led to a wholesale re-ordering of primary care service delivery. Virtually overnight, consultations moved to telephone calls or online interactions wherever possible. Service changes which have been debated at length and would ordinarily have taken years to implement became normal practice. In this chapter, we describe the NHS in England primary care policy response and locate this in a wider UK and international context, drawing on co-author Fisher’s frontline experience as a GP to describe how primary care organisations in one locality worked to create a new service. We then present findings from an empirical study supported by the Health Foundation to capture narratives from a sample of GPs, practice managers and community nurses in England and Scotland about their experiences of and responses to this unusual and shifting situation. We draw on analysis of qualitative longitudinal data captured in self-recordings, written contributions and short online interviews. The chapter concludes by discussing the ways in which primary health care professionals’ roles and identities may be changing as new forms of service provision emerge in response to the COVID-19 crisis. It is clear that the long-term implications of the pandemic on primary care and its practitioners are unknown
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